Lois Mathews writes: “Dear Pam, We hospital based IBCLC, also R.N. Are 
not gagged we can and do question Dr.s orders and challenge them when 
they give wrong info”.

Perhaps nurses are less gagged b/c they are more valued? Or perhaps 
they are just less likely to challenge docs on the issues we are 
talking about here. After all, it is usually the nurses who give most 
of the misinformation about breastfeeding that mothers receive in 
hospital. Just in the past two days, I have seen moms who have gotten 
horrible info/advice from nurses.

In my community, IBCLCs in hospital are told in no uncertain terms that 
there is information that they not allowed to give to mothers. I  had a 
hospital RN/IBCLC call me years ago to inform me that the hospital did 
not approve of my giving info about chiropractors to mothers who gave 
birth there b/c some of the peds did not like it!!!! She was perfectly 
comfortable saying this to me and did not see why I should do it if the 
doctors didn’t want me to. Ummm, b/c the mothers had a right to 
information that would help their babies heal from the trauma the 
hospital practices had inflicted upon them. She also thought the 
hospital had rightful authority over my practice!!!

I have also seen nurses agonizing behind the backs of doctors over 
things doctors did that they felt they could do nothing about. I saw 
this often in OB, especially when I did labor support. Most of the 
supportive things nurses did were very quietly done, lest they draw the 
attention and ire of the OB. They would openly lament “having to do 
things b/c the doc liked it this way” even though they clearly 
disagreed. OTOH, many nurses were in no way supportive and pushed as 
many poor practices as the OBs did. When my own son was in hospital, I 
found the PICU nurses very supportive of me, but they did not dare 
confront the doctors—they just quietly told me helpful things that 
supported my choices. I appreciated them very much, but the one RN who 
did actually support my rights directly to the doc was reprimanded for 
doing so. I will always be grateful to that nurse, but that should 
never have happened to her.

If nurses routinely question orders they, then why is it that there is 
routine supplementation of almost every baby in my community? Is it the 
case that the nurse’s opinions are generally just dismissed or is it 
that most nurses have no problems with this practice ?

And the value of the IBCLC credential.
Lynette Hafkin wrote:  “How will the random mother or lactation 
friendly hospital be able to determine who is really a gold-standard 
breastfeeding professional without the IBCLC credential? “

I don’t think the midwives, OB’s, peds or mothers who refer to me have 
any idea what IBCLC means. That is not for lack of trying on my 
part—but as long as I do a good job, that is really all they care 
about. They don’t understand the process and since anyone can be an LC, 
it is too much to sort out.

Lynette: “Right now, the IBCLC means that the LC has cared enough about 
demonstrating her knowledge and commitment that she has spent her own 
time and money to earn the IBCLC. Obviously half of all IBCLCs will be 
below average in their knowledge and skills, but that doesn't mean we 
should just chuck the whole thing!”

  This is just not true—there are many IBCLCs who did not spend their 
own money or time to take the test or get CERPS. There are also many 
IBCLCs who are not in any way committed to breastfeeding—some who even 
did not find that “breastfeeding was for them”. Also, I don’t think the 
exam is very rigorous, nor does it assess many of the skills I think 
should be most valued. As someone else said—if you are good at 
book-learning, you can easily pass, especially if you have a background 
in nursing.

Lynette: “There is no perfect system.But if all the excellent people 
leave the "pretty good" system, then we will be left with a badsystem.“

The thing is—I think it is already a very bad system—at least in the 
US.

Lynette: “There is a saying, "the perfect is the enemy of the good." I 
know we are all in this field because we believe in giving of ourselves 
to the cause of mothers and babies, not because we need to make the 
most money or have the most prestige. So think about what maintaining 
the institution of IBLCE will do for breastfeeding, even if it is 
currently facing some difficult issues. Not that you need to "give up" 
and adopt the bad SOP, just spend some time thinking of what the 
credential DOES for us, rather than what it doesn't do. Then let's 
figure out how we can get involved (even in a small way) in fixing 
things."

Maintaining the credential may do as much harm to breastfeeding as the 
“childbirth education” model has done to childbirth. It was co-opted by 
hospitals, became inculcated into the medical model and gave women a 
false sense of their own level of preparedness and ability to make 
choices in birth. I don’t think it needs to be fixed—I think it needs 
to be torn down and rebuilt with a new premise—-with normal 
physiological processes as the compass and a commitment to protect them 
in an honest, ethical and educated way as the framework for a SOP.

Patricia wrote: “ If the board certification is meant to be an addition 
to other credentialing then those of us without additional credentials 
who already are board certified will be grandfathered in. “

Who does this benefit? I have no desire to be the gatekeeper, saying 
that the next LLLL, doula, peer counselor or other committed person 
cannot become an IBCLC so long as I can practice. I also have no 
interest in being grandfathered into an organization which places the 
interest of the medical establishment above the interests of 
moms/babies and places  absurd restrictions on my practice, completely 
demeaning and degrading my years of work, commitment, education and 
success.

Veronica Tingzon writes:  “I am lucky. I have fought hard to get a job 
as an LC in a hospital, but I am called a lactation educator- as I am 
not an RN. A way to be paid less, I guess. I have no problem with this 
for now. I am still just starting out on my journey as a LC. I am, 
however, very saddened that my credentials are viewed as substandard 
just because I don't have that RN. I am forced to play the game,go back 
to school, spend countless hours away from my kids being in class and 
pursuing a degree I really don't want, in order to be viewed as a 
valuable LC.”

How can you say you are lucky, Veronica? You are a fully-credentialed 
IBCLC who is NOT ALLOWED to identify yourself by your rightful 
title???!!! I would say that bodes quite poorly for the profession.

Veronica: “I have seen many RN IBCLC or RN CLC that have "missed" very 
crucial components to the breast feeding situation. I have been the one 
who has discovered a baby's tight frenulum after the dyad has been seen 
2 or 3 times prior by an RN LC. I have been the one to tell a mom about 
an SNS when she had low milk supply and nothing else was working to get 
her baby's billirubin up after being seen by an RN LC. I have been the 
one to have mom try to BF after a breast reduction when an RN IBCLC 
told her she shouldn't bother because she won't make milk. “

I don’t know an LC in private practice who does not often have this 
experience.

Veronica: "I feel I received really stellar training from Gini Baker at 
the UCSD CLC course. Sure, there are other programs out there that may 
not be as good, but the proof should be in the pudding. Actions should 
speak louder than initials, folks.’

Yes, but what we are being told is that initials speak louder than 
anything and that the MD initials have authority over everyone 
(including mothers). It doesn’t matter how good you are—it matters that 
you are put in your place and never dare to contradict anyone with more 
important initials.

Jan Barger asked:  "Jennifer, I would like to know what you mean by 
"using nursing training as a foundation for building the credential."
  " While I don't agree with what is going on now, with the IBLCE 
backpedaling on their SOP stance (how silly to say it is just for the 
non-licensed HCP), I don't see that the founder used nursing education 
as a foundation. By the way, nurses are educated, not trained. Dogs are 
trained.“

  I do apologize for the poor choice of terminology—you are quite 
correct, of course.

  No, I do not think this was the original intent, but I do think that 
somewhere along the line, maybe ten years or so ago, things took a turn 
and the material that is the foundation of nursing education became the 
guideline for the education and evaluation of all IBCLCs.

  Jan: “It happens that nurses are in the right place to become IBCLCs 
as they are the people that are working with the mothers and babies in 
the hospitals, and as birth becomes more interventive (far more so now 
than it was in 1984 when the credential was first thought of -- and 
I've been an RN in MCH for more years than many of you are old, so I 
know whereof I speak....) mopping up the messes -- or trying to, 
anyway.”

  Yes, this is true, but that should not be enough, especially given the 
birth nightmare. Remember that as birth has become more medicalized, 
nurses in hospital have the opportunity to see fewer and fewer babies 
behaving in a normal way, nor do they have the opportunity to see how 
things go after the baby goes home. Often things get much, much worse 
and significant intervention on behalf of mom and baby are needed. 
There needs to be a two-fold effort on behalf of the dyad—-first from 
the hospital nurses and LCs and midwives, then from the private 
practice LCs. (Of course, once birth returns home, we can all find 
other things to do with ourselves.)

  Jan: “So it is not a credential that is designed only for health care 
professionals. It was designed for people of many backgrounds to become 
credentialed in order to legitimize their education and knowledge.”

  I do think that was the original design—but I do not think it is the 
intent any longer.

  Jan: “The fact that 20 years later the board was short sighted enough 
to write a scope of practice that benefits NOBODY should not be a 
reflection on the original intent. The question before us all is what 
are we going to do about it?
And one thing we are doing is working on a new scope of practice.”

  But, Jan—who is working on a new SOP? And who has the right to do so? 
I am sorry, but I cannot believe there will be an ethical, functional 
SOP written by non-IBCLCs or even by IBCLCs who are working from the 
medical model. An ethical SOP must serve mothers and babies and I have 
not seen them prioritzed in this whole debacle.


Lynnette Hafken writes:  “Did the 7 founders of LLL wring their hands 
that moms just should not be given twilight sleep and separated from 
their babies for days and then told to schedule feed? No, they figured 
out what needed to be done to change it, and did it. The climate they 
faced was MUCH worse than what we are facing now.”

I don’t think it was a worse situation. Infant and maternal mortality 
and morbidity rates are much worse now than then. Breastfeeding was not 
important enough (nor enough of a threat to the status quo) to become 
the domain of the medical model. As I see it, we now have the fox 
guarding the henhouse.

A better idea:
Sima Leah writes: "All I want to say is that It doesn't make sense to 
have to answer to someone who is not a specialist. keep them informed, 
yes, but not able to contradict, do.=
<snip>
  I for one am for more anatomy, physiology and endocrinology background 
information and maybe more intense learning of herbal and other health 
promoting remedies, rather than being in the shadow of a DOCTOR

Sima, I agree. It is a conflict of interest for me to “answer to” the 
very practice that has undermined birth and breastfeeding. We should 
set ourselves apart from the medical model, not be seduced by it. The 
fact is that so long as birth is so brutal, babies will not be able to 
breastfeed w/o a lot of assistance—and we need to have access to every 
tool at our disposal to allow that to happen. That includes our 
knowledge of nutrition, herbs, homeopathy, chiropractic, whatever we 
can bring to the table to heal these injured babies.

Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC



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